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Crown Lengthing PDF
Crown Lengthing PDF
LENGTHENING CHECKLIST
FOLLOW IT TO BE SUCCESSFUL WITH CROWN LENGTHENING| Pranadent LLC 2016 All rights reserved.
TRAINING IN CROWN LENGTHENING SURGERY
Congrats on your interest and involvement with crown lengthening surgery. I have no
doubt that you will gain great benefit from this training.
This procedure will enhance your restorative results and solve several of your challenges
to give your patients excellent outcomes.
No more compromise when a tooth fractures subgingivally. When caries extends beyond
an existing restoration, caries control is challenging and that trickles down to the process
of taking impressions and delivering a restoration. These problem happen daily in
private practice. No need to compromise.
The goal of this checklist is to organize your thinking when you have a potential crown
lengthening candidate. In the first training video, you learned about the main indications
for functional crown lengthening (there are more that Ill review in the course).
Now, you need to follow a system that will help you tackle the surgery. Youll need to
follow the proper steps and use the right instruments (all can be found in this document).
TRAINING IN CROWN LENGTHENING SURGERY
Although this is a relatively simple procedure, some doctors fail because of 3 things:
This checklist and the 3-part crown lengthening video training series will help help you
by tackling all 3.
You encountered a restorative challenge (subgingival fracture and caries) and you will be
really convincing when you offer this procedure.
Why?
Because the problem is just in front of you and you cant do your best without it. Its
almost obvious and a logical decision is to perform crown lengthening surgery.
TRAINING IN CROWN LENGTHENING SURGERY
Discuss the benefits: Better and more accurate finish line, better impression quality,
better future cementation and excess cement removal, better long-term maintenance
and.better future periodontal and bone stability.
Say no more.
TRAINING IN CROWN LENGTHENING SURGERY
Explain the benefits, risks and possible minor side effects (part 3 video in the video-
series will discuss COMPLICATIONS and their management). Go through the
informed consent process and have the form signed.
FINANCIAL ARRANGEMENT
Explain what this procedure will cost and dont forget to always talk about the value and
long-term benefits your patients will be getting.
You will be adding a surgical procedure that is indicated and you deserve to be
compensated for it. Your patients will be more invested financially to be getting a higher
quality treatment.
1. Make a provisional and schedule the patient for functional crown lengthening on a
separate date
2. Make a provisional. Take a break and set up immediately for crown lengthening
surgery
The next steps describe the steps and the exact instruments and burs
(Naturally youll provide good local anesthesia that is profound and long lasting. I
thought Id just throw this in:-).
INCISION OUTLINE
That will depend on the amount of attached and keratinized gingiva available in the
surgical site. It also depends on where the problem is, how many teeth are involved and
how close it is to the esthetic zone.
These points are SUPER important and well get deeper into that in our upcoming
webinar.
Generally, youll be using an internal bevel incision. A common incision outline extends
from line angle to line angle while skipping a tooth. That creates an
incision outline with surgical papillae. This will allow for your flap to adapt perfectly
around the teeth upon suturing. You can see the outline in the first video. If its not 100%
clear, dont stress out about it. I will make it clear in our future training videos and
webinars.
Tools:
v #15 blade on straight blade holder: creates the initial incision outline.
v Orban knife: repeat the incision line and remove the interproximal tissue.
FLAP REFLECTION
Generally, the most common, flap type is a full thickness flap with horizontal extensions
(envelope flap).
TOOLS:
v Periosteal elevator
TRAINING IN CROWN LENGTHENING SURGERY
OSTECTOMY
This is the part of vertical bone reduction. Youll need to account for the biologic width
and ferrule effect. Youll also have to understand the concept of POSITIVE
ARCHITECTURE. These 2 concepts will guide you in the vertical bone reduction
component of this procedure.
TOOLS:
v Crown lengthening bur (end cutting): There are 2 types: Large (with a 4mm
marking) and Small (for interproximal).
v Round diamond bur: thin-out the bone buccally to a very thin layer of bone and
then remove it with a straight chisel
OSTEOPLASTY
This is a super important step and also underutilized (and in my opinion not well
understood and definitely not taught enough). In this step you are removing non-
supporting bone which is changing the shape of bone. This will allow your flap to lay
passively and heal faster.
Why?
Because youre creating the natural bone architecture. Well go over these concepts in
much more detail later.
TRAINING IN CROWN LENGTHENING SURGERY
TOOLS:
v Large round diamond bur: Creates the channels (the concave areas).
v Large football bur: Connect the channels and create the convex part.
SUTURING
Once the ostectomy and osteoplasty are completed, the last step is to approximate the
tissues for optimal healing. If you followed all the previous steps, your flap will lay
passively.
Yes.
Your flap are well adapted over biologically re-shaped bone. No need to go fancy.
TOOLS:
It includes the necessary steps including the tools and burs youll need.
The overhead is relatively low (another great benefit of performing crown lengthening).
TRAINING IN CROWN LENGTHENING SURGERY
Look out for the next video on esthetic crown lengthening. Im getting so many warm
responses from dentists around the world.
If you like this way of learning and would like to incorporate crown lengthening
surgery in your practice you will LOVE participating in the online training. There is
much more to come.
In the next video Ill show you esthetic crown lengthening. After that well talk about
complications and at the end youll have to opportunity to train with me.
PS
Feel free to share this checklist with other dentists and you have my blessing to email it,
as well as the link to join the training at www.crownlengtheningsurgery.com
PS2
You are awesome for taking the time to learn and improve your surgical skills Give
yourself tons of credit. Most dentists dont do what youre about to learn..
TRAINING IN CROWN LENGTHENING SURGERY
FUNCTIONAL CROWN
LENGTHENING
CHECKLIST